Nationwide clinical practice variation for reconstructive surgery following oral cavity cancer from the Dutch Head and Neck Audit: are we all doing the same?

Quality registries provide real-world data that can drive quality improvement, which often starts with reducing inter-hospital variation. We explored outcomes and the extent of nationwide inter-hospital variation for patients undergoing reconstructive surgery after oral cavity cancer (OCC) using the Dutch Head and Neck Audit (DHNA). Within the DHNA, we selected all OCC patients who underwent curative reconstructive surgery between 2018 and 2022. Patient, tumour, and treatment characteristics were compared, including reconstruction strategies (skin grafting, local transposition, and pedicled and free flaps). Of those treated with free flap reconstruction, postoperative complications were scored according to the Clavien-Dindo (CD) classification and labelled minor (CD 1-2) or major (CD ≥3). A total of 1383 patients were included in the analysis. Especially in the case of patients with stage I tumours (10.1%) there was a wide variation in reconstructive surgery between centres, with a preference for local transposition (42.6%). Free flaps (n = 974) were used most often in patients with a more extensive tumour load (65.4-89.2%), with the radial forearm flap the preferred technique (54.7%, range range 37.1-80.8%). Thirty-four per cent of patients treated with a free flap had postoperative complications, with 38 cases of total flap loss (overall 3.9% complications). Strategies and percentages varied widely across centres, showing high inter-hospital variation in applied techniques and outcomes, and the need for national data improvement. Level of evidence: II.